| NPI | 1770678757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13397) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MD 8468) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |