| NPI | 1316426752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417733) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203682) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2021-10-29 |