| NPI | 1023200052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401415528) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415528) |
| 1223G0001X Dentist, General Practice (Licence: MD 16682) | |
| 1223G0001X Dentist, General Practice (Licence: CA 55849) | |
| 1223G0001X Dentist, General Practice (Licence: SC 9043) | |
| 1223G0001X Dentist, General Practice (Licence: NC 11318) | |
| 1223G0001X Dentist, General Practice (Licence: NV 5554) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2022-05-20 |