| NPI | 1528219755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: FL DN 17635) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN17635) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2018-03-12 |