| NPI | 1275881575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 34265) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62122) |
| Enumeration Date | 2012-08-17 |
| Last Update Date | 2020-06-30 |