| NPI | 1942302294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 104) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV S3-222C) |
| 122300000X Dentist (Licence: AR 3465) | |
| 122300000X Dentist (Licence: CA 101237) | |
| 122300000X Dentist (Licence: IL 109030995) | |
| 122300000X Dentist (Licence: KY 9869) | |
| 122300000X Dentist (Licence: LA 6020) | |
| 122300000X Dentist (Licence: MO 2009033293) | |
| 122300000X Dentist (Licence: OK 200) | |
| 122300000X Dentist (Licence: NY 58955) | |
| 122300000X Dentist (Licence: TN 9071) | |
| 122300000X Dentist (Licence: TX 25757) | |
| 122300000X Dentist (Licence: UT 10186273-9921) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2018-01-25 |