| NPI | 1487642641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NM DD2156) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00203125) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 11810) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2019-02-13 |