| NPI | 1356781736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203962) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT2510) |
| 1223G0001X Dentist, General Practice (Licence: FL DN20165) | |
| 261QD0000X Clinic/Center, Dental (Licence: CO 00203962) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2022-09-28 |