| NPI | 1891877650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: CO DEN.00202487) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54728) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2016-07-27 |