| NPI | 1245940964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00205875) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS108359) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2024-12-30 |