| NPI | 1730385659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AZ D6000) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 49836) |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 23044) | |
| 1223P0700X Dentist, Prosthodontics (Licence: IN 12010920A) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2007-07-08 |