| NPI | 1710345160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AL D-0007020-C) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO 00203968) |
| Enumeration Date | 2016-01-31 |
| Last Update Date | 2022-09-19 |