| NPI | 1275751414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: PR 001633) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN0014097) |
| 1223P0700X Dentist Prosthodontics (Licence: FL DN0014097) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2021-02-04 |