| NPI | 1356640882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00201963) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2011000216) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 62053) | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2016-03-02 |