| NPI | 1194019638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AZ D009285) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D009285) |
| 1223G0001X Dentist, General Practice (Licence: AZ D009285) | |
| 122300000X Dentist (Licence: AZ D009285) | |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2017-03-30 |