| NPI | 1184817330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00009523) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9523) |
| 1223G0001X Dentist, General Practice (Licence: NH 2381) | |
| 1223G0001X Dentist, General Practice (Licence: MA 11990) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2018-08-27 |