| NPI | 1043433188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10131) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 200609039343) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2018-04-11 |