| NPI | 1033277967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00010681) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00010681) |
| 122300000X Dentist (Licence: FL DN15462) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2023-03-22 |