| NPI | 1124450796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.00204141) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414105) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2023-05-16 |