| NPI | 1285067033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 00204675) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61064) |
| 1223P0300X Dentist, Periodontics (Licence: OK 90) | |
| 122300000X Dentist (Licence: TX 28885) | |
| 1223P0300X Dentist, Periodontics (Licence: TX 28885) | |
| 1223P0300X Dentist, Periodontics (Licence: KS 61064) | |
| 1223P0700X Dentist, Prosthodontics (Licence: OK 41) | |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 28885) | |
| 1223P0700X Dentist, Prosthodontics (Licence: KS 61064) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CO 00204675) | |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2023-06-26 |