| NPI | 1326452632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 30029) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038820) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2016-10-07 |