| NPI | 1124004601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: LA LA 5464) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 5464) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2023-09-13 |