| NPI | 1174580658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: ID D-3601) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D-3601) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2023-03-31 |