| NPI | 1457737454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 38164) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CT 11925) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MA DN1856970) | |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2023-06-14 |