| NPI | 1699194316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 202451) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 84-1343242) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2015-07-13 |