| NPI | 1003847625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DS017218L) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DA01718A) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-08 |