| NPI | 1639112311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: SC 2649) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS024608L) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2010-06-03 |