| NPI | 1427045236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 56564) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039820) |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 17058) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2023-02-28 |