| NPI | 1952651069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: ID D-4916-RD) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 61915) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NY 061449) | |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2021-04-02 |