| NPI | 1306229893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.00204273) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.024543) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DR.0063630) | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2024-10-03 |