| NPI | 1326394065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO 202267) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27053) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2014-08-15 |