| NPI | 1275148744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108234) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204527) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2022-10-27 |