| NPI | 1932660776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicinist (Licence: CO 00205064) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 733927104) |
| 122300000X Dentist (Licence: CO 00205064) | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2023-12-22 |