| NPI | 1033287016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 7434) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 122300000X Dentist (Licence: CO 7434) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2022-06-24 |