| NPI | 1164611455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 58078) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 5-0052292) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2020-02-03 |