| NPI | 1629025259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D5354) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 3093873-9924) |
| 122300000X Dentist (Licence: AZ 5354) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NC 11707) | |
| 207L00000X Anesthesiology (Licence: NC 11707) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2020-09-08 |