| NPI | 1962835553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: AL 5928) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5928) |
| 126900000X Dental Laboratory Technician (Licence: AL 233720-00) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2015-02-11 |