| NPI | 1619075991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS036064) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA DA031675) |
| 122300000X Dentist (Licence: CO 10625) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2026-07-23 |