| NPI | 1568471035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AZ D4649) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 4649) |
| 122300000X Dentist (Licence: CA 51814) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2019-02-28 |