| NPI | 1194042309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 056653) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021194) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MI 2901021194) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 2901021194) | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2025-10-21 |