| NPI | 1215912134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NY 050394-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 050394) |
| 122300000X Dentist (Licence: GA DN012894) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2014-06-18 |