| NPI | 1063681153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA 1858266) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NV S4-57C) |
| 1223P0300X Dentist, Periodontics (Licence: NM DD4650) | |
| 1223P0300X Dentist, Periodontics (Licence: TX 23620) | |
| 1223P0300X Dentist, Periodontics (Licence: MO 2020029625) | |
| 1223P0300X Dentist, Periodontics (Licence: VA 0401412001) | |
| 1223P0300X Dentist, Periodontics (Licence: CA 104862) | |
| 1223P0300X Dentist, Periodontics (Licence: TN 11216) | |
| 1223P0300X Dentist, Periodontics (Licence: KS 61781) | |
| 1223P0300X Dentist, Periodontics (Licence: KY 10817) | |
| 1223P0300X Dentist, Periodontics (Licence: CO 10224) | |
| 1223P0300X Dentist, Periodontics (Licence: OH 30.026700) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2023-05-17 |