| NPI | 1780232827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: WI 1002418-15) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901022830) |
| Enumeration Date | 2019-09-02 |
| Last Update Date | 2020-08-19 |