| NPI | 1427797323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1639) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00205130) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2023-10-02 |