| NPI | 1629214820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D7990) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57242) |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2016-06-29 |