| NPI | 1306907530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO DEN-10669) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 049231-1) |
| 1223G0001X Dentist General Practice (Licence: CT 008886) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-02-13 |