| NPI | 1629516364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204522) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 36127) |
| 122300000X Dentist (Licence: OH 30.025333) | |
| 122300000X Dentist (Licence: IN 12012640A) | |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2021-04-07 |