| NPI | 1306992730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 058889) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 3805) |
| 1223G0001X Dentist, General Practice (Licence: OK 6254) | |
| 1223G0001X Dentist, General Practice (Licence: LA 6142) | |
| 1223G0001X Dentist, General Practice (Licence: TX 0026365) | |
| 1223G0001X Dentist, General Practice (Licence: OH 30-020304) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2022-06-07 |