| NPI | 1972172971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00204758) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 00204758) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2023-07-12 |