| NPI | 1710225222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00202621) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413703) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2020-01-15 |