| NPI | 1780042010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: FL DN25627) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022100) |
| 1223G0001X Dentist General Practice (Licence: IL 19030547) | |
| 1223G0001X Dentist General Practice (Licence: TX 31635) | |
| 1223P0700X Dentist Prosthodontics (Licence: NJ 22DI02784000) | |
| 1223P0700X Dentist Prosthodontics (Licence: NY 060848) | |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2022-11-21 |