| NPI | 1780390914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN29788) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PA DS043096) |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2025-09-18 |