| NPI | 1629777552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122400000X Denturist (Licence: OR DT-DO-10222225) |
| Additional Taxonomies | 122400000X Denturist (Licence: WA DN61216096) |
| 126900000X Dental Laboratory Technician | |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2023-02-28 |