| NPI | 1689824484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 10243) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD1877) |
| 1223G0001X Dentist, General Practice (Licence: TX 17421) | |
| 1223G0001X Dentist, General Practice (Licence: IL 4300-015) | |
| 1223G0001X Dentist, General Practice (Licence: AZ 5016) | |
| 1223P0300X Dentist, Periodontics (Licence: NM DD1877) | |
| 1223P0300X Dentist, Periodontics (Licence: TX 17421) | |
| 1223P0300X Dentist, Periodontics (Licence: AZ 5016) | |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2016-09-23 |