| NPI | 1912133414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IA 40206) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 2394) |
| 122300000X Dentist (Licence: MD 16238) | |
| 1223P0700X Dentist, Prosthodontics (Licence: UT 10937970-9921) | |
| 1223P0700X Dentist, Prosthodontics (Licence: ME DEN4834) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2021-08-23 |