| NPI | 1386782324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6076) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WI 6076) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2019-03-04 |