| NPI | 1780930073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00201877) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 28248) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2022-07-21 |