| NPI | 1144291311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NC 5810) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: VA 0401005780) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2007-07-08 |