| NPI | 1003871005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 21978) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: KY 4565) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2007-07-08 |