| NPI | 1609322569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA DN05164) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401418741) |
| 1223P0700X Dentist, Prosthodontics (Licence: NC 14536) | |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2026-04-21 |