| NPI | 1225479538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 35600) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9536) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2022-04-01 |