NPI | 1548650948 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00008057) |
Additional Taxonomies | 122300000X Dentist (Licence: CO MODS.2766557) |
122300000X Dentist (Licence: MA DN19771) | |
124Q00000X Dental Hygienist (Licence: MA DH11262) | |
Enumeration Date | 2015-01-23 |
Last Update Date | 2018-11-09 |