| NPI | 1184033870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108477) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040011) |
| 1223G0001X Dentist, General Practice (Licence: AZ D010870) | |
| 1223G0001X Dentist, General Practice (Licence: TX 30351) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2024-02-26 |