| NPI | 1831533348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: UT 8330101-9926) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: UT 8330101-9922) |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2024-05-15 |