| NPI | 1124214333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO 00203569) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6725) |
| 1223P0700X Dentist, Prosthodontics (Licence: NE 6725) | |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2021-09-29 |