| NPI | 1457478794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: SC 10147) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA 18656) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2024-02-09 |