| NPI | 1750494498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN......173) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 173) |
| 1223G0001X Dentist, General Practice (Licence: CO DEN-173) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CO DEN-173) | |
| 1223G0001X Dentist, General Practice (Licence: IL 019-14025) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2014-02-27 |