| NPI | 1639158900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AL LNO3956) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL LNO3956) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2007-07-09 |