| NPI | 1053576843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10012) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8879) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2015-05-13 |