| NPI | 1639377955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN-9483) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12459) |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2021-08-04 |