| NPI | 1104783398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00206539) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 4900) |
| Enumeration Date | 2026-01-08 |
| Last Update Date | 2026-02-18 |