| NPI | 1841252996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MN D10642) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: WI 5388-15) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2010-01-28 |