| NPI | 1194099218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MO 2012015647) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2012015647) |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2025-06-03 |