| NPI | 1922239862 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61136) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD3160) |
| 122300000X Dentist (Licence: NM CS00214717) | |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00201929) | |
| 1223D0001X Dentist, Dental Public Health (Licence: CO DEN.00201929) | |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2016-05-19 |