| NPI | 1356443402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 9073131-9923) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO DEN9263) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2023-01-06 |