| NPI | 1568791440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00106346) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-022838) |
| 122300000X Dentist (Licence: CA 59659) | |
| 122300000X Dentist (Licence: WA DE60198298) | |
| 122300000X Dentist (Licence: OH RES.2658) | |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2016-05-27 |