| NPI | 1144482126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 9964) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 57146) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2013-08-07 |