| NPI | 1396009338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 9322) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL11540) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: KY 9322) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2022-04-12 |