| NPI | 1790033553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NV S1-28) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6216) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2024-04-22 |