| NPI | 1790177335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202685) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64231) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2018-05-08 |