| NPI | 1285981217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203480) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9514) |
| 122300000X Dentist (Licence: CO DEN.00203480) | |
| 1223G0001X Dentist, General Practice (Licence: TN 9514) | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2018-08-15 |