| NPI | 1356909683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00204003) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025798) |
| Enumeration Date | 2019-06-02 |
| Last Update Date | 2023-05-10 |