| NPI | 1659837417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: VA 0401415839) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: DC DEN1001964) |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2023-01-17 |