| NPI | 1093238610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00205471) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN29562) |
| 122300000X Dentist (Licence: CA 101669) | |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2024-09-29 |