| NPI | 1336125384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 15567) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX 15567) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2013-11-19 |