| NPI | 1073741104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CT 11042) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: NY P70931) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2013-08-22 |