| NPI | 1245406511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN00203398) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY P58817) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2018-11-20 |