| NPI | 1710004304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MD 8550) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: DC 4303) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |