| NPI | 1740413012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122400000X Denturist (Licence: OR DT-DO-1003340) |
| Additional Taxonomies | 126900000X Dental Laboratory Technician |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2009-09-02 |