| NPI | 1619043791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00007420) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 7920) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2023-06-23 |