| NPI | 1184849192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 9270) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9270) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2015-12-11 |