| NPI | 1770212409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D12169) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 12886440-9923) |
| 1223G0001X Dentist General Practice (Licence: CO DEN.00205216) | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-08-05 |