| NPI | 1215232103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NV S5-58C) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA DNF000419) |
| 1223P0700X Dentist, Prosthodontics (Licence: MN S136) | |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2022-11-17 |