| NPI | 1912600263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: OH 71.000297) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 71.000297) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2025-11-24 |