| NPI | 1851469704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NE 103) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401410696) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2008-02-20 |