| NPI | 1164624904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MD 5285) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 5285) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2007-07-08 |