| NPI | 1548512601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: TX 27864) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: PR 2908) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2024-01-11 |