| NPI | 1710963343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00010252) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NV S7-100C) |
| 1223G0001X Dentist, General Practice (Licence: MI L755471) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2018-10-22 |