| NPI | 1427252386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 203412) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 323095-9922) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2021-03-24 |