| NPI | 1730352683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: SC SC4340) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2023-08-03 |