| NPI | 1629465117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: OH 71.000243) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 71.000243) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2025-12-17 |