| NPI | 1811061849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6110) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 5751) |
| 1223G0001X Dentist, General Practice (Licence: TX 23828) | |
| 1223G0001X Dentist, General Practice (Licence: IA 08762) | |
| 1223G0001X Dentist, General Practice (Licence: OH 30-023269) | |
| 1223G0001X Dentist, General Practice (Licence: IN 12011461A) | |
| 1223G0001X Dentist, General Practice (Licence: AR 3737) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2011-05-04 |