| NPI | 1376731729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 9498) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 14123) |
| 122300000X Dentist (Licence: SD D1217) | |
| 122300000X Dentist (Licence: NE 7519) | |
| 122300000X Dentist (Licence: OH 30.023365) | |
| 122300000X Dentist (Licence: PA DS037059) | |
| 122300000X Dentist (Licence: TN 10901) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2020-04-11 |