| NPI | 1821688169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA DS043876) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 061751) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2026-01-05 |