| NPI | 1942652185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204151) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001352 - 15) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2022-02-04 |