| NPI | 1932433927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00201823) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6770) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00201823) | |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2024-02-21 |