| NPI | 1942871827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204838) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD5465) |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00204838) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2022-08-05 |