| NPI | 1174653158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: MI 2901019383) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 2901019383) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2024-01-25 |