| NPI | 1548541923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WI 6739-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6739-15) |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2018-05-02 |