| NPI | 1356328306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR 8403) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 6505) |
| 122300000X Dentist (Licence: WA DE00008636) | |
| 122300000X Dentist (Licence: IN 12009306A) | |
| 122300000X Dentist (Licence: PA DS024690L) | |
| 1223P0700X Dentist, Prosthodontics (Licence: OR 8403) | |
| 1223P0700X Dentist, Prosthodontics (Licence: KY 6505) | |
| 1223P0700X Dentist, Prosthodontics (Licence: WA DE00008636) | |
| 1223P0700X Dentist, Prosthodontics (Licence: IN 12009306A) | |
| 1223P0700X Dentist, Prosthodontics (Licence: PA DS024690L) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2007-07-08 |