| NPI | 1982088530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 17055) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 17055) |
| 1223G0001X Dentist, General Practice (Licence: TX 17055) | |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2015-07-14 |