| NPI | 1891936944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WV 3470) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NC 7260) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2009-03-19 |