| NPI | 1104840909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 6854) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN012573) |
| 1223G0001X Dentist, General Practice (Licence: MA 21449) | |
| 1223G0001X Dentist, General Practice (Licence: VA 0401411092) | |
| 1223G0001X Dentist, General Practice (Licence: IN 12010795A) | |
| 1223G0001X Dentist, General Practice (Licence: CO 8023) | |
| 1223G0001X Dentist, General Practice (Licence: SC 4176) | |
| 1223G0001X Dentist, General Practice (Licence: NM DD2095) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2009-07-09 |