| NPI | 1497280358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108679) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00203202) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2023-05-04 |