| NPI | 1790308286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D010936) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204475) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2024-04-09 |