| NPI | 1922607365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: SC 10000) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NC 12073) |
| Enumeration Date | 2020-10-17 |
| Last Update Date | 2025-02-17 |