| NPI | 1235532292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MD 16910) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 058971) |
| 122300000X Dentist (Licence: MA DN1856738) | |
| 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI02752000) | |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2022-01-05 |