| NPI | 1609397389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204293) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33090) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2024-07-25 |