| NPI | 1568426252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 00205792) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN d11579) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2023-12-08 |