| NPI | 1295040392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416278) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29671) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: TX 29671) | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: VA 0401416278) | |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2023-10-02 |