| NPI | 1427465178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO 00203172) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MN D13460) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2022-08-02 |