| NPI | 1588279350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10032) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204499) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2022-08-03 |