| NPI | 1093131161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 31371) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31371) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2022-12-28 |