| NPI | 1275814832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203596) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19541) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2021-11-22 |