| NPI | 1447489190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 203041) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055003-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2023-06-12 |