| NPI | 1457524175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4938) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 38682) |
| 122300000X Dentist (Licence: AZ D5620) | |
| 122300000X Dentist (Licence: NV 4938T) | |
| 122300000X Dentist (Licence: CA 44301) | |
| 122300000X Dentist (Licence: NV 4938) | |
| 1223G0001X Dentist, General Practice (Licence: TN 11884) | |
| Enumeration Date | 2008-04-03 |
| Last Update Date | 2022-09-28 |