| NPI | 1831189794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 34855) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: KS 6691) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2021-08-13 |