| NPI | 1811251598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CO DEN.00201932) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: UT 8322701-9922) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2025-07-03 |