| NPI | 1548709611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401415419) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 32535) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |