| NPI | 1457427106 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 122400000X Denturist (Licence: MI 013561) | 
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 013561) | 
| Enumeration Date | 2006-11-27 | 
| Last Update Date | 2025-09-11 |