| NPI | 1033147905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CA 50865) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: TX 12568) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-07-08 |