| NPI | 1942429956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00201941) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ND 1825) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2013-08-01 |