| NPI | 1063781425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist Oral and Maxillofacial Radiology (Licence: UT 7827882-9922) |
| Additional Taxonomies | 1223X0008X Dentist Oral and Maxillofacial Radiology (Licence: CA 59617) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2017-12-04 |