| NPI | 1164860581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401418837) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CO DEN00010699) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2024-08-12 |