| NPI | 1528473386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: TX 33331) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6453) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2022-07-21 |