| NPI | 1740511344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: ID D-4284) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: OR D9413) |
| 1223P0700X Dentist, Prosthodontics (Licence: WA DE00010231) | |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2012-01-16 |