| NPI | 1811549918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203979) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203979) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2024-08-16 |