| NPI | 1215413356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO DEN.00203934) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 100523) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2019-05-26 |