| NPI | 1417398280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00202199) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4508) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2014-05-07 |