| NPI | 1215100144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IA 40172) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 046793-1) |
| 1223P0700X Dentist, Prosthodontics (Licence: IL 019.26023) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 58605) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2017-04-11 |