| NPI | 1295740603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: CO 7214) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: CO 7214) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |