| NPI | 1053300756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN00202320) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6559) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2024-02-14 |