| NPI | 1083625792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 44540) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9057) |
| 1223G0001X Dentist, General Practice (Licence: AZ 6274) | |
| 1223G0001X Dentist, General Practice (Licence: NV 4908) | |
| 1223G0001X Dentist, General Practice (Licence: MO 2012027620) | |
| 1223G0001X Dentist, General Practice (Licence: KS 61076) | |
| 1223G0001X Dentist, General Practice (Licence: VA 0401415880) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2018-11-19 |