| NPI | 1447543822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31418) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: TX 31418) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2016-09-13 |