| NPI | 1891227898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: UT 10306848-9922) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: NV S5-48) |
| 1223P0700X Dentist Prosthodontics (Licence: CA 100186) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2018-01-31 |