| NPI | 1588672968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56890) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21175) |
| 1223G0001X Dentist, General Practice (Licence: IL 019026105) | |
| 1223G0001X Dentist, General Practice (Licence: AK 1143) | |
| 1223G0001X Dentist, General Practice (Licence: AZ 5790) | |
| 1223G0001X Dentist, General Practice (Licence: WA DE 00009499) | |
| 1223G0001X Dentist, General Practice (Licence: IA 08706) | |
| 1223G0001X Dentist, General Practice (Licence: WI 5673-15) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2015-03-12 |