| NPI | 1881641785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO DEN-9172) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO 9172) |
| 1223G0001X Dentist General Practice (Licence: WA DE00005852) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2012-02-10 |