| NPI | 1528182888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 17770) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WI 2403-015) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |