| NPI | 1063413847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 51210) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA 009784) |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 041483-1) | |
| 1223P0700X Dentist, Prosthodontics (Licence: ME 3189) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2007-07-08 |