| NPI | 1629132303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 34723) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN-8825) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 102080) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2019-09-13 |