| NPI | 1497121669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204834) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31383) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2023-12-11 |