| NPI | 1184824922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN-00010504) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55903) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2016-05-16 |