| NPI | 1174969190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 28813) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 28813) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2026-03-03 |