| NPI | 1619345840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NV S5-47C) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: KS 61138) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2020-06-05 |