| NPI | 1679521926 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AK 1204) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL 7418) |
| 1223P0700X Dentist, Prosthodontics (Licence: AL 3544) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-07-08 |