| NPI | 1235410200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO 10693) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 60293) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2019-09-27 |