| NPI | 1699745950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO DEN-7566) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 18569) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-09-17 |