| NPI | 1083082515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DS040417) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2018015359) |
| 122300000X Dentist (Licence: PA DS040417) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MO 2018015359) | |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2024-03-21 |