| NPI | 1083068027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MD 15922) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA dds-09045) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2020-03-11 |