| NPI | 1841281482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN00201832) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS005302) |
| 1223G0001X Dentist, General Practice (Licence: TN 5302) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2015-07-16 |