| NPI | 1427370154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CO 10102) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 23733) |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2021-01-15 |