| NPI | 1013293760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 00203801) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DEN.00203801) |
| 1223E0200X Dentist, Endodontics (Licence: WY 1517) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2013042229) | |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2019-12-11 |