| NPI | 1043455371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NC 9664) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7074787-9921) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2020-05-19 |