| NPI | 1649750142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401416179) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416179) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2023-06-27 |