| NPI | 1750587051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IA 8465) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00205467) |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2023-04-05 |