| NPI | 1043325319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: CO DEN.00008879) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: CO 8879) |
| 1223D0004X Dentist Dentist Anesthesiologist (Licence: CO DEN.00008879) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2018-11-30 |