| NPI | 1700261369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204235) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN5036) |
| 122300000X Dentist (Licence: WI 1001496-15) | |
| 1223G0001X Dentist, General Practice (Licence: MA DN1859701) | |
| 1223G0001X Dentist, General Practice (Licence: TN 11193) | |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2023-07-13 |