| NPI | 1790914364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: DC DEN1000853) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MD 13966) |
| Enumeration Date | 2009-07-04 |
| Last Update Date | 2013-07-10 |