| NPI | 1669520300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10403) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 33872) |
| 1223G0001X Dentist, General Practice (Licence: WY 1044) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-02-07 |