| NPI | 1407001811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: VA 040142934) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TN 9109) |
| 122300000X Dentist (Licence: CA 57656) | |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2021-10-05 |