| NPI | 1376863068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR 9969) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN-10208) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2015-01-02 |