| NPI | 1306139514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30015) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX F-26367) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2017-05-09 |