| NPI | 1538194063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: OH 30.024430) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NY 054838) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2015-09-05 |