| NPI | 1225478753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MA DN1858064) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NH 04536) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2020-01-27 |