| NPI | 1265460497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 28864) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 04014111498) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2015-07-31 |