| NPI | 1700472602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 7424TU) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 7424) |
| 1223E0200X Dentist Endodontics (Licence: NV 7424) | |
| 1223G0001X Dentist General Practice (Licence: NV 7424) | |
| 1223P0300X Dentist Periodontics (Licence: NV 7424) | |
| 1223P0700X Dentist Prosthodontics (Licence: NV 7424) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV 7424) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NV 7424) | |
| 1223X2210X Dentist Orofacial Pain (Licence: NV 7424) | |
| 122400000X Denturist (Licence: NV 7424) | |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2022-12-29 |