| NPI | 1669116646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00206026) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: IL 019.033570) | |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2024-09-05 |