| NPI | 1720570559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN00203681) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN23375) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-07-03 |