| NPI | 1467582577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO AD.0000515) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 150533) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2017-02-23 |