| NPI | 1942725635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203304) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13831) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2017-08-03 |