| NPI | 1194702332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CO DEN.00202208) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00009431) |
| 122300000X Dentist (Licence: VA 0401008859) | |
| 1223E0200X Dentist Endodontics (Licence: SC 003922) | |
| 1223E0200X Dentist Endodontics (Licence: CO 00202208) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2021-11-29 |