| NPI | 1063433985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MT 2215) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 2215) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2020-12-09 |