| NPI | 1508266750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CT 011277) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15680) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2016-01-04 |