| NPI | 1255578373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NC 0090) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: ZZ 2640) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2009-01-12 |