| NPI | 1215997218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8912) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02267600) |
| 1223G0001X Dentist, General Practice (Licence: NY 051348) | |
| 1223G0001X Dentist, General Practice (Licence: VA 0401412359) | |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1000810) | |
| 1223G0001X Dentist, General Practice (Licence: MD 13993) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2015-11-02 |