| NPI | 1710235031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: WI 6921) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 35861) |
| 1223P0700X Dentist Prosthodontics (Licence: WI 6921-15) | |
| 1223G0001X Dentist General Practice (Licence: WI 6921-15) | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2021-06-18 |