NPI | 1982195533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204865) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6870) |
Enumeration Date | 2018-05-18 |
Last Update Date | 2022-10-27 |