| NPI | 1235261272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA 8956) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: SC 2237) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-08 |