| 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 |