| NPI | 1386942498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203550) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009193) |
| 122300000X Dentist (Licence: TX 28069) | |
| 122300000X Dentist (Licence: UT 7758098-9921) | |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2018-08-14 |