| NPI | 1871831594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO DEN.00202558) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D008637) |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2017-03-22 |