| NPI | 1184760472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA 8289) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN008289) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-01-28 |