| NPI | 1851777304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO GEN.02786194) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 11742) |
| 122300000X Dentist (Licence: CO 203024) | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2020-12-10 |