| NPI | 1780647982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MD 12383) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 12383) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2023-02-24 |