| NPI | 1932621547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 33417) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401415767) |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2017-08-10 |