| NPI | 1225362684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PR 2838) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PR 2838) |
| 208600000X Surgery (Licence: PR 2838) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: PR 2838) | |
| 207ZI0100X Pathology, Immunopathology (Licence: PR 2838) | |
| 207ZC0500X Pathology, Cytopathology (Licence: PR 2838) | |
| 122300000X Dentist (Licence: PR 2838) | |
| 1223G0001X Dentist, General Practice (Licence: PR 2838) | |
| 261Q00000X Clinic/Center (Licence: PR 2838) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PR 2838) | |
| 207ZP0213X Pathology, Pediatric Pathology (Licence: PR 2838) | |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2026-05-11 |