| NPI | 1912230533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CT 12337) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055875-1) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401412638) | |
| 1223G0001X Dentist, General Practice (Licence: CT 12337) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 055875-1) | |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: CT 12337) | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2019-04-16 |