NPI | 1790308286 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D010936) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204475) |
Enumeration Date | 2020-05-19 |
Last Update Date | 2024-04-09 |