NPI | 1043664188 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: VA 0401416381) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS040743) |
1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NC 10942) | |
Enumeration Date | 2016-04-14 |
Last Update Date | 2019-02-05 |