| NPI | 1184249658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-5490) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204398) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2023-03-21 |