| NPI | 1740893791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 10327) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: PA DS042900) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2022-11-11 |