| NPI | 1619631413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00204856) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204856) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D11868) | |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2023-08-29 |