| NPI | 1285619783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO DEN.00201915) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN D9560) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2022-06-17 |