| NPI | 1669511481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00205888) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D5683) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2024-09-19 |