| NPI | 1780656835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: UT 5155416-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 51554169921) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2023-01-20 |