| NPI | 1669701819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: CA 58762) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58762) |
| 1223D0004X Dentist Dentist Anesthesiologist (Licence: TX 27582) | |
| 122300000X Dentist (Licence: TX 27582) | |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2014-03-04 |