| NPI | 1598008153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CO 00203432) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: FL DTP679) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NY 059585) | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2020-02-26 |