NPI | 1831348572 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205328) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 57617) |
1223G0001X Dentist, General Practice (Licence: VA 0401415471) | |
Enumeration Date | 2008-09-18 |
Last Update Date | 2023-04-07 |