| NPI | 1104806041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00007213) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.019810) |
| 1223G0001X Dentist, General Practice (Licence: VT 16-0000997) | |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00007213) | |
| 1223G0001X Dentist, General Practice (Licence: CA 53740) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2022-07-21 |