| NPI | 1861001646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00204600) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2020025847) |
| 1223G0001X Dentist, General Practice (Licence: KS 61675) | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2023-12-02 |