| NPI | 1992018048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 2299) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD3350) |
| 122300000X Dentist (Licence: TX 27291) | |
| 122300000X Dentist (Licence: AZ D008871) | |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2021-08-12 |