NPI | 1710022470 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO 105849) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CO 105849) |
Enumeration Date | 2007-02-20 |
Last Update Date | 2007-07-08 |