NPI | 1699194316 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO 202451) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 84-1343242) |
Enumeration Date | 2014-04-09 |
Last Update Date | 2015-07-13 |