| NPI | 1326332800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205553) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 0026562) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2023-09-28 |