| NPI | 1073636122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00202407) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5685033-9922) |
| 122300000X Dentist (Licence: NV 6758) | |
| 122300000X Dentist (Licence: WY 1410) | |
| 122300000X Dentist (Licence: MT DEN-DEN-LIC-7792) | |
| 122300000X Dentist (Licence: TX 31825) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2016-09-09 |