| NPI | 1851693113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IA FAC-40214) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 286875) |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2022-10-24 |