| NPI | 1164899423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: GA DN122241) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IA DDS-09245) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DS042724) | |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2024-04-18 |