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 |