| NPI | 1942271432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AZ D009045) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 61935) |
| 1223P0700X Dentist, Prosthodontics (Licence: MD 13409) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2015-02-05 |