| NPI | 1902880008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MD 16278) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: OH 30-01-8617) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2019-03-13 |