| NPI | 1578948287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: PA RFD000032) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: IA RES-30448) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2024-10-25 |