| NPI | 1023421435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203803) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6593) |
| 1223G0001X Dentist, General Practice (Licence: AK 104605) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2023-09-12 |