| NPI | 1598287369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203264) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA DDS-10377) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2025-11-10 |