| NPI | 1972501369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO Hd-16000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.0016000) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2019-06-16 |