| NPI | 1548492887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00202191) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 70461369921) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 26118) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2020-09-23 |