| NPI | 1144281767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00203331) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 6555) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2017-10-25 |