| NPI | 1013463983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 203821) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ND 2297) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2023-06-19 |