| NPI | 1154300044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 9174) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401008190) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2007-07-08 |