| NPI | 1285024729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD4679) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 202437) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2023-07-20 |