| NPI | 1023290889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: FL DN17952) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 22020) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2012-01-20 |