| NPI | 1508929753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA 61262027) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: OH 71-0000152) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2025-01-21 |