| NPI | 1851853485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 00204060) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204060) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2025-03-06 |