| NPI | 1477897734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: TX 32713) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8145) |
| 122300000X Dentist (Licence: TN 10980) | |
| 1223P0700X Dentist Prosthodontics (Licence: SC 8145) | |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2024-07-17 |