| NPI | 1023332350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NM DD4212) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: CA 59183) |
| 1223P0300X Dentist Periodontics (Licence: TX 24695) | |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2018-03-17 |