| NPI | 1730252982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014629) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 23737) |
| 1223G0001X Dentist, General Practice (Licence: WA DE00010701) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: ID d-4407-pd) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 27304) | |
| 122300000X Dentist (Licence: UT 6545604-9923) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2016-06-13 |