| NPI | 1326036443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 05154) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5154) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2022-07-21 |