| NPI | 1659943371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205916) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 12341536-9921) |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2025-04-14 |