| NPI | 1114464716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CO DEN.00203052) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00203052) |
| Enumeration Date | 2017-01-21 |
| Last Update Date | 2020-10-06 |