NPI | 1902416027 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO DEN.00204403) |
Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204403) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-08-04 |
Last Update Date | 2024-07-10 |