| NPI | 1134773849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204055) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61741) |
| 122300000X Dentist (Licence: CO DEN.00204055) | |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2024-06-30 |