| NPI | 1538158043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CA SP-251) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CT 9026) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2010-03-02 |