| NPI | 1366703001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204628) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19647) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2021-11-30 |