| NPI | 1720318439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NM DD3741) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24741) |
| 122300000X Dentist (Licence: NM DD3741) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 24741) | |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2023-07-14 |