| NPI | 1821481250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009692) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00202345) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2018-09-06 |