| NPI | 1841032679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CA DDS106453) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: MA DN1859079) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NY 062459) | |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2024-06-11 |