| NPI | 1003807603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA DNF000454) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WI 6607) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2023-04-13 |