| NPI | 1710329529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202263) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00202263) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2022-06-07 |