| NPI | 1568075554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D11314) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00205808) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2023-11-08 |