| NPI | 1497168223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00202996) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CO DEN00202996) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2023-07-17 |