| NPI | 1215348412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NJ 22DI02617400) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: NY 057243) |
| 1223P0700X Dentist Prosthodontics (Licence: PA DS040932) | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2016-08-23 |