| NPI | 1740766344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203559) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33280) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2018-07-17 |