| NPI | 1730108200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN-814) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO HD100814) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-02-12 |