| NPI | 1922263912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO 00202500) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO GEN.02786119) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.023911) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D12883) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24164) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00202500) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00202500) | |
| Enumeration Date | 2008-07-19 |
| Last Update Date | 2022-07-21 |