| NPI | 1871679415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN02285) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901016737) |
| 122300000X Dentist (Licence: NJ 22DI01757400) | |
| 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI01757400) | |
| 1223P0700X Dentist, Prosthodontics (Licence: MI 2901016737) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2023-09-26 |