| NPI | 1417565748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205034) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.032774) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2025-03-13 |