NPI | 1366460545 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NM DD4504) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 56404) |
122300000X Dentist (Licence: OR 9973) | |
122300000X Dentist (Licence: UT 92160589921) | |
122300000X Dentist (Licence: TX 33797) | |
122300000X Dentist (Licence: PA DS043347) | |
1223G0001X Dentist, General Practice (Licence: HI 1256) | |
Enumeration Date | 2006-07-17 |
Last Update Date | 2022-09-29 |