| NPI | 1851477814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: KS 60172) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MN D9863) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2022-07-21 |