| NPI | 1033404132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: SC 8164) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: FL DN30382) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2026-01-22 |