| NPI | 1629181474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: TX 19990) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: MD 11676) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |