| NPI | 1841216561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 57138) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 20814) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2010-07-20 |