| NPI | 1255324893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA DE00010932) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NE 6468) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2020-09-14 |