| NPI | 1629429907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NE 7346) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO DEN.00202883) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2023-10-25 |