| NPI | 1427240282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7351) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00201822) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2015-07-29 |