| NPI | 1720216070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN20441) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 052991) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2018-01-10 |