| NPI | 1275844730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI02596400) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1855438) |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 057740-1) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2015-09-23 |