| NPI | 1770584401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401414381) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WV 3466) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2014-12-26 |