| NPI | 1215013966 |
|---|---|
| Former Name | KARL L HICKEY |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 8755) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 8755) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2009-03-12 |