| NPI | 1255627147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MD 11569) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: DC 5618) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2012-04-19 |