| NPI | 1629429444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00202876) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO 202876) |
| 1223G0001X Dentist General Practice (Licence: CO 202876) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2021-02-08 |