| NPI | 1588150098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61238428) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 7305) |
| 122300000X Dentist (Licence: TX 35779) | |
| 122300000X Dentist (Licence: NM DD4947) | |
| 122300000X Dentist (Licence: WA DE61238428) | |
| 1223G0001X Dentist, General Practice (Licence: NM DD4947) | |
| 1223G0001X Dentist, General Practice (Licence: NV 7305) | |
| 1223G0001X Dentist, General Practice (Licence: TX 35779) | |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2022-09-01 |