| NPI | 1124400890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 00204685) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4670) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2021-12-28 |