| NPI | 1871040451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00205246) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD5260) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2022-10-31 |