| NPI | 1134112907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: MD 15830) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 20734) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2025-07-21 |