| NPI | 1043346489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: DC 2914) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MD 5549) |
| 1223P0700X Dentist, Prosthodontics (Licence: FL DN6058) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-08 |