| NPI | 1255599700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008161) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D008161) |
| 1223G0001X Dentist, General Practice (Licence: ID D4135) | |
| 1223G0001X Dentist, General Practice (Licence: NY 057826-1) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2018-04-10 |