| NPI | 1922606870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO DEN.00205944) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 36731) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2025-07-01 |