| NPI | 1184154387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NC 12165) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO DEN.00204323) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2021-03-26 |