| NPI | 1962677559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: DC DEN5196) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401008318) |
| 1223P0700X Dentist, Prosthodontics (Licence: MD 11228) | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2013-06-19 |