| NPI | 1831475375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00202536) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D9683) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2015-06-29 |