| NPI | 1124015383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CO 06160) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: VA 0401008531) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2007-07-08 |