NPI | 1649797861 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204142) |
Additional Taxonomies | 122300000X Dentist (Licence: NM DD4785) |
Enumeration Date | 2017-08-28 |
Last Update Date | 2020-06-24 |