| NPI | 1548473523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CT 009509) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 009509) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-05-13 |