| NPI | 1174979991 |
|---|---|
| Former Name | RICARDO CARLO CARRILLO GIRALDO |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 23339) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 1507) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2021-01-11 |