| NPI | 1437355872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL HAD129) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 7722) |
| 1223G0001X Dentist, General Practice (Licence: NY 5410205) | |
| 1223G0001X Dentist, General Practice (Licence: NV 4591) | |
| 1223G0001X Dentist, General Practice (Licence: AZ 6091) | |
| 1223G0001X Dentist, General Practice (Licence: CA 54414) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2024-03-07 |