| NPI | 1447632245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO DEN.00202805) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 6216) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2016-07-01 |