| NPI | 1417346727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 101047) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00202418) |
| Enumeration Date | 2015-01-10 |
| Last Update Date | 2017-02-28 |