| NPI | 1184129793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00204088) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 12029) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-10-17 |