| NPI | 1760908446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 14066) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 111542) |
| 122300000X Dentist (Licence: WI 1001668) | |
| 122300000X Dentist (Licence: VA 0401417077) | |
| 1223G0001X Dentist, General Practice (Licence: MO 2024018541) | |
| 122300000X Dentist (Licence: IL 019.031991) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN122591) | |
| 1223G0001X Dentist, General Practice (Licence: WI 1001668) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2026-08-27 |