| NPI | 1215379060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: VA 0401414904) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: OH RES.3383) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DS040197) | |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2020-02-26 |