| NPI | 1669786430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NC 9243) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 32443) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2021-01-31 |