| NPI | 1467686311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZA2600X Specialist/Technologist, Other, Art, Medical (Licence: WV 1028-9815) |
| Additional Taxonomies | 126900000X Dental Laboratory Technician (Licence: WV 1028-9815) |
| 247200000X Technician, Other (Licence: WV 1028-9815) | |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2009-05-06 |