NPI | 1982044160 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00202911) |
Additional Taxonomies | 122300000X Dentist (Licence: ME RES81) |
1223P0221X Dentist, Pediatric Dentistry (Licence: HI DT 2607) | |
Enumeration Date | 2013-07-02 |
Last Update Date | 2022-04-17 |