| NPI | 1881671436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 3209) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051116) |
| 1223G0001X Dentist, General Practice (Licence: ID D-3858) | |
| 1223G0001X Dentist, General Practice (Licence: OH 22044) | |
| 1223G0001X Dentist, General Practice (Licence: IN 12010429A) | |
| 1223G0001X Dentist, General Practice (Licence: OK 5641) | |
| 1223G0001X Dentist, General Practice (Licence: AZ 5641) | |
| 1223G0001X Dentist, General Practice (Licence: NV 4778T) | |
| 1223G0001X Dentist, General Practice (Licence: KS 60210) | |
| 1223G0001X Dentist, General Practice (Licence: NM DD2043) | |
| 1223G0001X Dentist, General Practice (Licence: WY 1134) | |
| 1223G0001X Dentist, General Practice (Licence: MA 21280) | |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2007-07-09 |