| NPI | 1649868159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601001) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE.61126175) |
| 122300000X Dentist (Licence: CO DEN.00204551) | |
| 122300000X Dentist (Licence: WA DENT.DE.61126175) | |
| Enumeration Date | 2021-01-10 |
| Last Update Date | 2021-10-26 |