| NPI | 1821681164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 7437) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 105974) |
| 122300000X Dentist (Licence: CT 2.012997) | |
| 122300000X Dentist (Licence: MA DN1858898) | |
| 122300000X Dentist (Licence: TX 37000) | |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2021-03-18 |