| NPI | 1992321400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204546) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO T-DEN.00000050) |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2021-07-07 |