| NPI | 1568748218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203852) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12971) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2024-04-19 |