| NPI | 1649294422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 64047) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 051909-1) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2017-03-29 |