| NPI | 1649117664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00206617) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 14267792-9926) |
| Enumeration Date | 2026-04-29 |
| Last Update Date | 2026-04-29 |