| NPI | 1407135676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202117) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 00202117) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2022-08-24 |