| NPI | 1205053881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9081) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55470) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901018661) | |
| 1223G0001X Dentist, General Practice (Licence: HI 2205) | |
| 1223G0001X Dentist, General Practice (Licence: NY 052602) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2014-12-01 |