| NPI | 1730705179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204794) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO T-DEN.00000046) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2024-04-03 |