| NPI | 1801226931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA DNF000386) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 34516) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2021-10-25 |