| NPI | 1811413610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 16541) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MD 16541) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2025-02-28 |