| NPI | 1477942548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12705) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 62029) |
| 122300000X Dentist (Licence: TX 38148) | |
| 122300000X Dentist (Licence: VA 0401414714) | |
| 122300000X Dentist (Licence: NV 7625) | |
| 122300000X Dentist (Licence: CO DEN.00205317) | |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2023-02-01 |