| NPI | 1124242730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 11307) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN00202549) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2026-06-03 |