| NPI | 1669533725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: SC 4182) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA DN013298) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2018-07-12 |