| NPI | 1265815997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA DNF000405) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 35962) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2022-07-12 |