| NPI | 1023694460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 12728) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033438) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-06-10 |