| NPI | 1316308596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00202908) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202908) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2026-07-06 |