| NPI | 1710081716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NE 114) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IA 40084) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2008-02-15 |