| NPI | 1154724508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: TX 30822) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: LA P-137) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2021-06-15 |