| NPI | 1578799953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204441) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25406) |
| 122300000X Dentist (Licence: MI 2901019999) | |
| Enumeration Date | 2009-05-30 |
| Last Update Date | 2021-04-07 |