| NPI | 1811953276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: UT 145092-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-3060) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-12-20 |