| NPI | 1043211899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: VA 041412314) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TN DS0000010158) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DSO23468L) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2019-01-31 |