| NPI | 1790801330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22290) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011229) |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00205000) | |
| 1223G0001X Dentist, General Practice (Licence: TN 11495) | |
| 1223G0001X Dentist, General Practice (Licence: WA DE61135095) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN122275) | |
| 1223G0001X Dentist, General Practice (Licence: NC 12345) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2024-10-15 |