| NPI | 1891765756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 040141202) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN012635) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2012-06-18 |