| NPI | 1619760196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00206300) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DEN.00206300) |
| Enumeration Date | 2025-05-27 |
| Last Update Date | 2025-06-03 |