| NPI | 1871541276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO DEN.00009325) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD5009) |
| 1223G0001X Dentist, General Practice (Licence: TX 14481) | |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 14481) | |
| 122300000X Dentist (Licence: CO DEN.00009325) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-04-14 |