| NPI | 1407323165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00205750) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10946) |
| 122300000X Dentist (Licence: OR D10946) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2023-09-27 |