| NPI | 1578600318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 8806) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MT 11499) |
| 1223G0001X Dentist, General Practice (Licence: NV 4702) | |
| 1223G0001X Dentist, General Practice (Licence: CO 8806) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2022-07-21 |