| NPI | 1245647411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 7621) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00203467) |
| 122300000X Dentist (Licence: TX 30267) | |
| 122300000X Dentist (Licence: ID D-5007) | |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2022-05-16 |