| NPI | 1417907338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00009022) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00009022) |
| 122300000X Dentist (Licence: NY 054351) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-03-10 |