| NPI | 1669096194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 205069) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00000023) |
| 122300000X Dentist (Licence: AK 166927) | |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2025-01-03 |