| NPI | 1386898914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 7771) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ d012098) |
| 122300000X Dentist (Licence: OK 7800) | |
| 1223G0001X Dentist, General Practice (Licence: FL DN18040) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 58233) | |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2025-06-15 |