NPI | 1598170532 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00203498) |
Additional Taxonomies | 122300000X Dentist (Licence: MD 15588) |
Enumeration Date | 2014-06-28 |
Last Update Date | 2018-07-04 |