| NPI | 1558360073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8471CO) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CO 8471) |
| 1223G0001X Dentist, General Practice (Licence: CO 8471) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2012-08-31 |