| NPI | 1104964295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 13162) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 13162) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2024-03-28 |