| NPI | 1659542215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 8495) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN-9427) |
| 122300000X Dentist (Licence: WA DE60118562) | |
| 122300000X Dentist (Licence: UT 8892816-9921) | |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2014-05-16 |