| NPI | 1306897152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10014) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6382) |
| 1223G0001X Dentist, General Practice (Licence: NC 8514) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2009-11-20 |