| NPI | 1588186852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 36350) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PA ds041403) |
| Enumeration Date | 2017-07-08 |
| Last Update Date | 2023-09-01 |