| NPI | 1790475465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205677) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN28070) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2023-06-20 |