| NPI | 1598958548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00010745) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57971) |
| 1223G0001X Dentist, General Practice (Licence: WA DE60046233) | |
| 1223G0001X Dentist, General Practice (Licence: IA 08515) | |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2022-07-21 |