| NPI | 1992715304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00202790) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3896) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-03-27 |