| NPI | 1497026165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: DC 5571) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401008781) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2012-01-26 |