| NPI | 1548994775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO .00205356) |
| Additional Taxonomies | 122400000X Denturist (Licence: MI 2901601362) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2022-11-22 |