| NPI | 1477109486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0442000563) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 151262) |
| 122300000X Dentist (Licence: NC 12982) | |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2025-07-14 |