| NPI | 1306861653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: SC 3340) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: SC 475) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-08 |