| NPI | 1265717391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 101517) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 31503) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2022-11-22 |