| NPI | 1003838459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 11353) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 11353) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-08-09 |