| NPI | 1811370588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202758) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 6184711-9922) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2023-01-04 |