| NPI | 1073248928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00205288) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D011765) |
| 1223G0001X Dentist, General Practice (Licence: CO 00205288) | |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2023-09-04 |