| NPI | 1609910678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: FL DN16119) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16119) |
| 122300000X Dentist (Licence: AK D817) | |
| 122300000X Dentist (Licence: NE 4698) | |
| 122300000X Dentist (Licence: OR D8066) | |
| 122300000X Dentist (Licence: WA DE00009340) | |
| 122300000X Dentist (Licence: CA 40052) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2016-04-05 |