| NPI | 1174531818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00203973) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN D11792) |
| 1223E0200X Dentist, Endodontics (Licence: AK 1460) | |
| 1223G0001X Dentist, General Practice (Licence: MN D11792) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2023-06-22 |