| NPI | 1336497585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202686) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3752) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2023-08-07 |