| NPI | 1427455195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 30682) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00202435) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2020-04-14 |