| NPI | 1144438946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202432) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901015674) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2016-06-08 |