| NPI | 1114085289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 1839) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: SC 1839) |
| 1223P0700X Dentist, Prosthodontics (Licence: SC 1839) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 1839) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 1839) | |
| 122300000X Dentist (Licence: SC 1839) | |
| 1223E0200X Dentist, Endodontics (Licence: SC 1839) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2018-05-30 |