| NPI | 1932515160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31271) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00202252) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2022-01-17 |