| NPI | 1083988729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 27734) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27734) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2026-07-17 |