| NPI | 1811984339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA 61191466) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 14700) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2022-02-11 |