| NPI | 1467884973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MD LL861) |
| Additional Taxonomies | 125Q00000X Oral Medicine (Licence: MD LL861) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MA DL12001) | |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2025-12-15 |