| NPI | 1952370322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist Oral and Maxillofacial Radiology (Licence: FL DTP438) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DTP438) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2018-10-13 |