NPI | 1700495991 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204457) |
Additional Taxonomies | 122300000X Dentist (Licence: CO T-DEN.00000053) |
Enumeration Date | 2020-07-23 |
Last Update Date | 2020-09-10 |