| NPI | 1457901696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 00205818) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 104437) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2025-05-30 |