| 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 |