| NPI | 1184910994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00203556) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL HAD34) |
| 1223G0001X Dentist, General Practice (Licence: UT 80136689921) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2021-08-16 |