| NPI | 1558568402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 30547) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PR 2768) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2021-01-07 |