| NPI | 1720562150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203984) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 10854655-9922) |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2026-02-09 |