| NPI | 1427026095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO DEN-8475) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D4260) |
| 1223G0001X Dentist General Practice (Licence: OK 4783) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2012-06-01 |