NPI | 1376922138 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO DEN.00204959) |
Additional Taxonomies | 122300000X Dentist (Licence: OH res3606) |
122300000X Dentist (Licence: CO DEN.00204959) | |
Enumeration Date | 2015-05-27 |
Last Update Date | 2025-06-03 |