| NPI | 1841487352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: SC 4676) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA DN015271) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2017-03-15 |