| NPI | 1386052579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 34870) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 9936) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2024-08-01 |