| NPI | 1619463106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00203775) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS102449) |
| Enumeration Date | 2018-07-08 |
| Last Update Date | 2023-01-24 |