| NPI | 1831291855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 04176) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CO CO01476) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2021-09-01 |