| NPI | 1144576240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DS039158) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039158) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2018-03-17 |