| NPI | 1346727898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00205739) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901022782) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2025-08-05 |