| NPI | 1578186169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 39174) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 39174) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-07-22 |