| NPI | 1275888281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401417269) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MD 17214) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2021-04-16 |