| NPI | 1174933519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NC 11682) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VT 016.0107689) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2020-07-08 |