| NPI | 1770743387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CO DEN.00202539) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS-037905) |
| 122300000X Dentist (Licence: NE 6755) | |
| 208600000X Surgery (Licence: CO DR.0055864) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2022-09-09 |