| NPI | 1720102882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: OK 4455) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 4455) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2019-05-08 |