| NPI | 1487591319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: OR D12296) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: WA DE61627491) |
| Enumeration Date | 2026-04-29 |
| Last Update Date | 2026-04-29 |