| NPI | 1992992838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN-10064) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8502) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2012-02-21 |