| NPI | 1003983297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO DEN.00206149) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: UT 359370-9922) |
| 1223G0001X Dentist General Practice (Licence: IA DDS-09806) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2025-08-11 |