| NPI | 1992911762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10254) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5924773-9922) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2017-11-29 |