| NPI | 1801158985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 37218) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204443) |
| 1223G0001X Dentist, General Practice (Licence: AZ D008453) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2021-06-19 |