| NPI | 1033450721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 62192) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 054765) |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2013-03-06 |