| NPI | 1659378701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: CO 04515) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 104515) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2008-04-25 |