| NPI | 1295040566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: ID D4409PR) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4409-PR) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2026-05-29 |