| NPI | 1437669280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205084) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001764) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2022-08-19 |