| NPI | 1245200104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 21321) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 0021321) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2023-03-27 |