| NPI | 1063676641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 054459) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 61068) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2016-10-10 |