| NPI | 1841553120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D008375) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ d008375) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 60944) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 30599) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MS 3827-15) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2015-09-03 |