| NPI | 1497838262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: KY 8565) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MD 2901009195) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2011-02-18 |