| NPI | 1326489576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34629) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202010) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2021-02-04 |