| NPI | 1154540821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00205434) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 043221) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2024-09-23 |