| NPI | 1487645164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN-22473) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401414710) |
| 1223P0700X Dentist, Prosthodontics (Licence: PA DS-025715-L) | |
| 1223P0700X Dentist, Prosthodontics (Licence: FL DN-22473) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2018-12-14 |