| NPI | 1639536055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202861) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2015030707) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2023-10-03 |