| NPI | 1609832807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA DE00009289) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401007314) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2012-03-30 |