| NPI | 1912582537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: WA DE61426091) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: ME DEN5155) |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2026-02-12 |