| NPI | 1831788694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00205518) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO GEN.02786225) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2023-09-13 |