| NPI | 1356341580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WI 4775015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 4775015) |
| 1223P0700X Dentist, Prosthodontics (Licence: PR 002499) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2024-04-02 |