| NPI | 1760731855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA DS041061) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056846-1) |
| 1223G0001X Dentist, General Practice (Licence: FL DN 19914) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2017-07-13 |