| NPI | 1265451744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: WI 5000-942-015) |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0700X Dentist Prosthodontics | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |