| NPI | 1760540652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA 9565) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NC 5025) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |