| NPI | 1255408381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO 9265) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043094) |
| 1223G0001X Dentist, General Practice (Licence: CO 9265) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2021-09-23 |