| NPI | 1982849212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO 00202230) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7134265-9921) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2018-05-08 |