| NPI | 1558801852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00203736) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MI 2901022122) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2019-02-28 |