| NPI | 1598803108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NC 13635) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: WA DE00009647) |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2025-04-08 |