| NPI | 1194841858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO 9525) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 19712) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-07-23 |