| NPI | 1831248079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL dn15255) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7545) |
| 122300000X Dentist (Licence: PR 3154) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2018-05-22 |