| NPI | 1720108061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 8098519-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 7082) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2021-11-10 |