| NPI | 1366813362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 6732) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 65194) |
| 122300000X Dentist (Licence: OK 6988) | |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2021-09-10 |