NPI | 1487968459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00201903) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25839) |
Enumeration Date | 2010-08-03 |
Last Update Date | 2014-09-12 |