| NPI | 1275013641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205474) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001908) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2025-01-07 |