| NPI | 1558385351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN012562) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN7829) |
| 1223G0001X Dentist, General Practice (Licence: SC D4000) | |
| 1223G0001X Dentist, General Practice (Licence: VA 0401411091) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN012562) | |
| 1223G0001X Dentist, General Practice (Licence: MA 21450) | |
| 1223G0001X Dentist, General Practice (Licence: IN 1201799A) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2017-11-03 |