| NPI | 1255380309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202425) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 9887) |
| 122300000X Dentist (Licence: PA DS028015L) | |
| 1223G0001X Dentist, General Practice (Licence: PA DS028015L) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2023-02-13 |