| NPI | 1538846464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00206156) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID Pending) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2025-03-17 |