| NPI | 1740649839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO DEN.00202851) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO 00202851) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2019-11-19 |