| NPI | 1629171160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN01856) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 37456) |
| 1223G0001X Dentist, General Practice (Licence: NY 048628-1) | |
| 1223G0001X Dentist, General Practice (Licence: VA 0401411240) | |
| 1223G0001X Dentist, General Practice (Licence: MA 21505) | |
| 1223G0001X Dentist, General Practice (Licence: IN 12010805A) | |
| 1223G0001X Dentist, General Practice (Licence: AZ 7025) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-08 |