| NPI | 1669665485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: GA DN014685) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: CO DEN-9527) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2014-11-02 |