| NPI | 1972898716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00010446) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN-10446) |
| 1223E0200X Dentist, Endodontics (Licence: IA DDS-09233) | |
| 1223G0001X Dentist, General Practice (Licence: CO DEN-10446) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30378) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2021-08-02 |