| NPI | 1205823689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN-6074) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 4981) |
| 1223G0001X Dentist, General Practice (Licence: KS 5765) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2007-07-08 |