| NPI | 1033373113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 22403) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22403) |
| 1223P0700X Dentist, Prosthodontics (Licence: IL 22403) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2019-05-22 |