| NPI | 1083736219 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CT 010375) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CT 010375) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2014-07-17 |