| NPI | 1023205119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: TX 21868) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 21868) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2011-09-13 |