| NPI | 1043862006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 103955) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00205527) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2023-05-01 |