| NPI | 1659793552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122400000X Denturist (Licence: OR dt-do 10157767) |
| Additional Taxonomies | 122400000X Denturist (Licence: WA dn 60404066) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2017-02-17 |