| NPI | 1528376266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: FL DN24541) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: NV 7187) |
| 1223P0700X Dentist Prosthodontics (Licence: CA 60612) | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2020-12-27 |