| NPI | 1649438292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO DEN.00010294) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00010294) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2018-11-19 |