| NPI | 1083704530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CT 009266) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 051230-1) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2007-07-08 |