| NPI | 1013014984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5359) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 11920) |
| 1223G0001X Dentist, General Practice (Licence: OH 30-022103) | |
| 1223G0001X Dentist, General Practice (Licence: IN 12010776A) | |
| 1223G0001X Dentist, General Practice (Licence: AR 3549) | |
| 1223G0001X Dentist, General Practice (Licence: NE 6596) | |
| 1223G0001X Dentist, General Practice (Licence: WA DE00010483) | |
| 1223G0001X Dentist, General Practice (Licence: VA 0401411321) | |
| 1223G0001X Dentist, General Practice (Licence: AZ 6898) | |
| 1223G0001X Dentist, General Practice (Licence: CO 9308) | |
| 1223G0001X Dentist, General Practice (Licence: IL 019.027257) | |
| 1223G0001X Dentist, General Practice (Licence: AK 1222) | |
| 1223G0001X Dentist, General Practice (Licence: TN DS0000008614) | |
| 1223G0001X Dentist, General Practice (Licence: PA DS037081) | |
| 1223G0001X Dentist, General Practice (Licence: IA 08453) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-11-19 |