| NPI | 1104131572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NE 6902) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6902) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2016-08-26 |