| NPI | 1255809810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IA 40219) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: OR DF0044) |
| Enumeration Date | 2018-11-12 |
| Last Update Date | 2023-03-06 |