| NPI | 1811955321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CO DEN.00006501) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 013927) |
| 1223P0700X Dentist Prosthodontics (Licence: CO 6501) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2022-10-25 |