| NPI | 1891908661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: DC 2923) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: VA 4170) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MD 5621) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-09 |