| NPI | 1780608562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 7546) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00007546) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-09-03 |