| NPI | 1164676235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D7680) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D7680 13011379-M) |
| Enumeration Date | 2008-11-15 |
| Last Update Date | 2016-02-29 |