| NPI | 1750695417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN00203466) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9472) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2019-06-20 |