| NPI | 1689839409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: VA 0447000074) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57316) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 57316) | |
| 122300000X Dentist (Licence: VA 0401415377) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2016-10-26 |