| NPI | 1376809863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009480) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 39778) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2023-08-25 |