| NPI | 1316420581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 38695) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041944) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2022-07-13 |