| NPI | 1083943906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: CO DEN.00205009) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: KY 8817) |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2023-03-13 |