| NPI | 1770936171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009672) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202857) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2022-07-21 |