| NPI | 1588758015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23688) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051472-1) |
| 1223P0700X Dentist, Prosthodontics (Licence: NC 9211) | |
| 122300000X Dentist (Licence: NC 9211) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2015-08-13 |