NPI | 1821315433 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN10717) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3485) |
Enumeration Date | 2010-04-23 |
Last Update Date | 2016-07-05 |