| NPI | 1982058368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 33630) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 18102-875) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2022-10-06 |