| NPI | 1598735003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MD 10572) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DS025429L) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2013-10-10 |