| NPI | 1043374762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: ME 2168) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MA 9474) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NH 3312) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: RI DEN02483) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2007-07-08 |