| NPI | 1780831016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA dn013764) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA DN013764) |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 056055) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2015-01-09 |