| NPI | 1245376011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401412383) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA 20173) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2010-12-01 |