| NPI | 1699808857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: MI 2901016040) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901016040) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 2901016040) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-01-29 |