| NPI | 1730721978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: MD LL914) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NC 151260) |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2026-01-05 |