| NPI | 1679721054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD3940) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58624) |
| 122300000X Dentist (Licence: AZ D7651) | |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2021-03-26 |