| NPI | 1073126322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN00204465) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DRPM2440) |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00204465) | |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2025-07-29 |