| NPI | 1306225206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30999) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61166289) |
| 1223G0001X Dentist, General Practice (Licence: GA DN122570) | |
| 1223G0001X Dentist, General Practice (Licence: TN 11568) | |
| 1223G0001X Dentist, General Practice (Licence: SC 10111) | |
| 1223G0001X Dentist, General Practice (Licence: GA D011465) | |
| 1223G0001X Dentist, General Practice (Licence: NC 12526) | |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00205046) | |
| 1223G0001X Dentist, General Practice (Licence: FL DN24794) | |
| Enumeration Date | 2015-05-25 |
| Last Update Date | 2024-05-02 |