| NPI | 1154305605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: KY 7975) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 7975) |
| 1223P0700X Dentist, Prosthodontics (Licence: VA 0401419590) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2025-07-09 |