| NPI | 1932278629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA DN006851) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WA DE60399541) |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 051185) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 61328) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2024-11-07 |