NPI | 1942626833 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00202840) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS038772) |
Enumeration Date | 2014-03-15 |
Last Update Date | 2018-03-17 |