| NPI | 1376825083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 27162) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27162) |
| 1223G0001X Dentist, General Practice (Licence: TX 027162) | |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2022-03-23 |