| NPI | 1346337714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 4792) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4792) |
| 1223G0001X Dentist, General Practice (Licence: NE 6542) | |
| 122300000X Dentist (Licence: UT 325161) | |
| 122300000X Dentist (Licence: TX 24285) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2012-08-28 |