| NPI | 1164986923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204646) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61512) |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2022-06-17 |