| NPI | 1063640316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DR.0058466) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 0024657) |
| 122300000X Dentist (Licence: CO DEN.00202720) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 0024657) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2022-10-26 |