| NPI | 1124431200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 6504) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64416) |
| 1223E0200X Dentist Endodontics (Licence: NV 6504) | |
| 1223P0300X Dentist Periodontics (Licence: NV 6504) | |
| 1223P0700X Dentist Prosthodontics (Licence: NV 6504) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV 6504) | |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2023-06-12 |