| NPI | 1477723583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI02664100) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NC 6222) |
| 1223P0700X Dentist, Prosthodontics (Licence: GA DN011085) | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2021-06-24 |