| NPI | 1184044661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 055394) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA DN21489) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |