| NPI | 1750682662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204924) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 9215) |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2022-01-05 |