| NPI | 1083749675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA DS022015L) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 034745) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2015-11-02 |