| NPI | 1932709987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 40232) |
| Additional Taxonomies | 122400000X Denturist (Licence: MA DL14578) |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2024-03-18 |