| NPI | 1407176019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CO 202554) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 202554) |
| 1223G0001X Dentist General Practice (Licence: CO 202554) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2020-09-24 |