| NPI | 1952851842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205505) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041026) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2023-06-08 |