| NPI | 1588218143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DTP763) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: OK F-016) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2022-06-16 |