| NPI | 1821422908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN23627) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414082) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2020-09-23 |