| NPI | 1003173576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO 00201856) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: UT 8590166-9924) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2022-07-21 |