| NPI | 1487169827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D011057) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 557) |
| 122300000X Dentist (Licence: CO DEN00204218) | |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2021-08-23 |