| NPI | 1467403253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: WA DE00008680) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: OR D8732) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2011-05-31 |