| NPI | 1386892651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: PR 2832) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054160) |
| 122300000X Dentist (Licence: PR 2832) | |
| 1223P0700X Dentist Prosthodontics (Licence: NY 054160) | |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2012-10-19 |