| NPI | 1487740270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IA 09146) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NC 6265) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-09-27 |