NPI | 1720648454 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00206131) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858304) |
Enumeration Date | 2019-06-14 |
Last Update Date | 2025-06-19 |