| NPI | 1518604545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: MD 18322) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859531) |
| Enumeration Date | 2022-05-20 |
| Last Update Date | 2025-05-30 |