| NPI | 1609932292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0401007058) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401007058) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2025-09-11 |