| NPI | 1578864781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN 202161) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9562) |
| 122300000X Dentist (Licence: CA D26831) | |
| 122300000X Dentist (Licence: AK 1358) | |
| 122300000X Dentist (Licence: WA DE60144920) | |
| 122300000X Dentist (Licence: KY 9405) | |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2023-03-07 |