| NPI | 1881913143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: UT 8163067-9924) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8163067-9924) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2016-05-06 |