| NPI | 1255356598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL 11583) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 11583) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2010-08-11 |