| NPI | 1740267517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401008419) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MD 10387) |
| 1223P0700X Dentist, Prosthodontics (Licence: PA DS024094L) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2025-09-11 |