| NPI | 1063455921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: SC 9723) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DA022458A) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-04-13 |