| NPI | 1619955929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: UT 5933858-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5933858) |
| 1223P0700X Dentist, Prosthodontics (Licence: UT 5933858-9926) | |
| 1223P0700X Dentist, Prosthodontics (Licence: TN 9453) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2023-10-05 |