| NPI | 1477854396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00202189) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN00202189) |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2021-07-12 |