| NPI | 1972898716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IA DDS-09233) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00010446) |
| 1223E0200X Dentist, Endodontics (Licence: CO DEN.00010446) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2026-01-08 |