| NPI | 1205837853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 104138) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00104138) |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2018-04-10 |