| NPI | 1770780645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: RI DAPA02663) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI DEN02883) |
| 207L00000X Anesthesiology (Licence: MA 2130220) | |
| 122300000X Dentist (Licence: MA 21302) | |
| 122300000X Dentist (Licence: NY 051644) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 0223000 Masshealth) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 0223000 Doral Dental) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA AGHDrexel OMS) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2008-10-12 |