| NPI | 1003150673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 39452) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN18981) |
| 1223P0300X Dentist, Periodontics (Licence: DC DEN1001822) | |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2024-03-19 |