| NPI | 1982957775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00201989) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6313) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2020-08-31 |