| NPI | 1528188075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA DN009410) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL DN0010263) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2024-02-16 |