| NPI | 1124336227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL Dn24770) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WV 4066) |
| 1223P0700X Dentist, Prosthodontics (Licence: OH 30-023337) | |
| 1223P0700X Dentist, Prosthodontics (Licence: GA DN013980) | |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2021-12-09 |