| NPI | 1689787053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO DEN-10064) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 104893) |
| 1223G0001X Dentist General Practice (Licence: WI 5001697) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2012-02-10 |