| NPI | 1669897906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: UT 9057947-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9057947-9922) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2024-05-08 |