| NPI | 1417331067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: FL DN30000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12012872A) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2025-08-03 |