| NPI | 1467884973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicinist (Licence: MD LL861) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MA DL12001) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2020-02-21 |