| NPI | 1750728119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MI 2901600423) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ d008715) |
| Enumeration Date | 2013-05-25 |
| Last Update Date | 2020-05-20 |