| NPI | 1588976856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO 00205050) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020221) |
| 122300000X Dentist (Licence: IN LDR180208) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2023-10-25 |