| NPI | 1558422394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS106022) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 18687) |
| 1223G0001X Dentist, General Practice (Licence: AZ D010991) | |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00204633) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2022-05-05 |