| NPI | 1477865657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00010233) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN-10233) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2018-03-17 |