| NPI | 1821767245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: CO 00204899) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: OH 30.019299) |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2021-10-13 |