| NPI | 1003103789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN10665) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN-10665) |
| 1223G0001X Dentist, General Practice (Licence: UT 8013484-9922) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2025-05-09 |