| NPI | 1467550400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: AL 5391C) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 5391C) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: AL 5391C) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-07-09 |