| NPI | 1720463664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00202588) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00202588) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2021-04-07 |