| NPI | 1063609295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AZ D010253) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WA 00009710) |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 52776) | |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2022-01-02 |