| NPI | 1689774341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WI 5806015) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 12024) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2007-07-23 |