| NPI | 1538780325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204688) |
| Enumeration Date | 2020-05-03 |
| Last Update Date | 2021-06-03 |