| NPI | 1760751770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NE 6988) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6988) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2023-11-29 |