| NPI | 1831348572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205328) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57617) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401415471) | |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2023-04-07 |