| NPI | 1457354870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26430) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 19-15320) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.023585) | |
| 1223G0001X Dentist, General Practice (Licence: WI 1002349-15) | |
| 1223G0001X Dentist, General Practice (Licence: AK DENT1384) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2022-05-04 |