| NPI | 1629205612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00202789) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6108) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2016-07-07 |