| NPI | 1730477084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO 10468) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CO 00010468) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2020-12-28 |