| NPI | 1992900179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA 14011) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 028984) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2007-07-08 |