| NPI | 1356539449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NC 9013) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL dn16729) |
| 1223P0700X Dentist, Prosthodontics (Licence: FL dn16729) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2020-08-28 |