| NPI | 1851643795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 28436) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 28436) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-10-02 |