| NPI | 1134315815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NC 8144) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 22137) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2007-09-17 |