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 |