| NPI | 1003671520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: UT 13682344-9926) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA DN122976) |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-02-14 |